Acute GI Bleeding

Question 1

What is upper GI bleeding?

Answer 1

Proximal to ligament of Trietz
- Oesophagus
- Stomach
- Duodneum

Question 2

What is the clinical presentation of upper GI bleeding?

Answer 2

• Haematemesis
• Melaena
• Elevated urea
• Dyspepsia, reflux, epigastric pain
• NSAIDs use

Question 3

What is haematemesis?

Answer 3

Vomiting of blood
May be red or look like coffee grounds

Question 4

What is melaena?

Answer 4

Black motions often like tar, with a characteristic smell of altered blood.

Question 5

What are the oesophageal causes of upper GI bleeding?

Answer 5

• Oesophageal ulcer
• Oesophagitis
• Oesophageal varices
• Mallory Weiss tear
• Oesophageal malignancy

Question 6

What are the stomach causes of upper GI bleeding?

Answer 6

• Gastric ulcer
• Gastritic
• Gastric varices
• Gastric malignancy
• Dieulafoy
• Angiodysplasia

Question 7

What are the duodenal causes of upper GI bleeding?

Answer 7

• Duodenal ulcer
• Duodenitis
• Angiodysplasia

Question 8

What are the most common causes of upper GI bleeding?

Answer 8

Peptic ulcers
Gastritis
Oesophagitis
Erosive duodenitis
Varices
Portal hypertensive gastropathy
Malignancy
Mallory Weiss tear
Valvular deformation- angiodysplasia, dieulafoy

Question 9

What are the risk factors for peptic ulcers?

Answer 9

H. pylori
NSAIDs
Aspirin
Alcohol excess
Systemic illness

Question 10

What are varices?

Answer 10

Abnormally dilate collateral vessels

Question 11

What varices are most common?

Answer 11

Oesophageal- 90%
Gastric- 8%
Rectal and splenic- rare

Question 12

What is Mallory- Weiss tear?

Answer 12

Linear tear to GO junction
Follows period of retching/vomiting

Question 13

What is angiodysplasia?

Answer 13

Vascular malformation anywhere along the GI tract
Frequent cause of chronic occult or overt occult bleeding

Question 14

What is diuelafoy?

Answer 14

Submucosal arteriolar vessel eroding through mucosa in the gastric fundus

Question 15

What is lower GI bleeding?

Answer 15

Distal to ligament of Trietz
- Jejunum
- Ileum
- Colon

Question 16

What is the clinical presentation of lower GI bleeding?

Answer 16

• Fresh blood/clots
• Magenta stools
• Normal urea
• Typically painless
• More common in advanced age

Question 17

What are the causes of lower GI bleeding?

Answer 17

Diverticular disease
Haemorrhoids
Vascular malformations
- Angiodysplasia
- Arteriovenous malformation (AVM)
Neoplasia
- Carcinoma
- Polyps
Ischaemic colitis
Radiation enteropathy/proctitis
IBD
- UC
- CD

Question 18

What is diverticular disease?

Answer 18

Protrusion of inner mucosal lining through the outer muscular layer forming a pouch

Question 19

What is haemorrhoids?

Answer 19

Enlarged vascular cushions around anal canal

Question 20

What is lower GI neoplasia?

Answer 20

Colonic polyps or carcinoma

Question 21

What is ischaemic colitis?

Answer 21

Disruption in blood supply to colon

Question 22

What is radiation proctitis?

Answer 22

History of radiotherapy:
- Cervical cancer
- Prostate cancer

Question 23

What are the small bowel causes of lower GI bleeding?

Answer 23

• Meckel’s diverticulum
• Small bowel angiodysplasia
• Small bowel tumour/ GIST
• Small bowel ulceration (NSAID associated)
• Aortoentero fistulation (following AAA repair)

Question 24

What are the steps for management of acute GI bleeding?

Answer 24

1. Resuscitation
2. Risk stratification
3. Diagnosis + treatment
   
   1. Upper GI: Endoscopy
   2. Lower GI: Colonoscopy or CT angiogram
4. Withhold/reverse contributory medications
5. Specific medications
   
   1. PPI
   2. Tranexamic acid
6. Consider CT angiography/interventional radiography/ surgical interventions

Question 25

What is the management for peptic ulcers?

Answer 25

Endoscopy
PPIs
Angiography with embolization
Laparotomy

Question 26

What is the management for varices?

Answer 26

Endoscopy
Terlipressin
Antibiotics
Reverse abnormal coagulation
Sengstaken blakemore tube
Transjugular intrahepatic portosystemic chunts (TIPSS)